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1.
Sensors (Basel) ; 21(17)2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34502748

RESUMO

One of the most common sleep disorders is sleep apnea. It manifests itself by episodes of shallow breathing or pauses in breathing during the night. Diagnosis of this disease involves polysomnography examination, which is expensive. Alternatively, diagnostic doctors can be supported with recordings from the in-home polygraphy sensors. Furthermore, numerous attempts for providing an automated apnea episodes annotation algorithm have been made. Most of them, however, do not distinguish between apnea and hypopnea episodes. In this work, a novel solution for epoch-based annotation problem is presented. Utilizing an architecture based on the long short-term memory (LSTM) networks, the proposed model provides locations of sleep disordered breathing episodes and identifies them as either apnea or hypopnea. To achieve this, special pre- and postprocessing steps have been designed. The obtained labels can be then used for calculation of the respiratory event index (REI), which serves as a disease severity indicator. The input for the model consists of the oronasal airflow along with the thoracic and abdominal respiratory effort signals. Performance of the proposed architecture was verified on the SHHS-1 and PhysioNet Sleep databases, obtaining mean REI classification error of 9.24/10.52 with standard deviation of 11.61/7.92 (SHHS-1/PhysioNet). Normal breathing, hypopnea and apnea differentiation accuracy is assessed on both databases, resulting in the correctly classified samples percentage of 86.42%/84.35%, 49.30%/58.28% and 68.20%/69.50% for normal breathing, hypopnea and apnea classes, respectively. Overall accuracies are 80.66%/82.04%. Additionally, the effect of wake periods is investigated. The results show that the proposed model can be successfully used for both episode classification and REI estimation tasks.


Assuntos
Síndromes da Apneia do Sono , Humanos , Polissonografia , Respiração , Taxa Respiratória , Sono , Síndromes da Apneia do Sono/diagnóstico
2.
Rev Assoc Med Bras (1992) ; 67(3): 360-365, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468598

RESUMO

OBJECTIVE: To evaluate the effect of the treatment of obstructive sleep apnea syndrome on overactive bladder symptoms. METHODS: All patients who applied to the outpatient clinic with complaints of snoring and apnea were evaluated by polysomnography between years 2017 and 2019. obstructive sleep apnea syndrome severity was evaluated according to the apnea-hypopnea-index. All patients were filled with questionnaire form as overactive bladder symptoms score, international quality of life, international consultation on incontinence questionnaire short-form, and 3-day bladder diary before polysomnography and three months after continuous positive airway pressure therapy and surgical treatment. RESULTS: A total of 125 patients, 34 (27.2%) patients with mild obstructive sleep apnea syndrome, 27 (21.6%) patients with moderate obstructive sleep apnea syndrome, and 64 (51.2) patients with severe obstructive sleep apnea syndrome were included in the study. The prevalence of overactive bladder symptoms in three obstructive sleep apnea syndrome groups were 67.6, 53.8, and 48.4%, respectively, and there was no statistical difference between the groups (p=0.190). obstructive sleep apnea syndrome treatment such as surgical treatment or continuous positive airway pressure therapy was applied to 45.5% (31 patients) patients with obstructive sleep apnea syndrome and overactive bladder. Three months after treatment, the overactive bladder symptoms score significantly decreased from 16.1±7.9-12.80±9.82, international quality of life was significantly increased from 105.0±23.2-110.4±22.2, and incontinence questionnaire short-form decreased from 11.9±4.0-10.4±5.6 (p=0.009, p=0.023, and p=0.248, respectively). There was a significant decrease between before and after treatment in terms of mean day-time frequency and mean urgency episodes of patients (p=0.007, p=0.002). CONCLUSIONS: Both surgery and continuous positive airway pressure treatment of obstructive sleep apnea syndrome improved overactive bladder symptoms, overactive bladder symptoms score, international quality of life, day-time frequency, and urgency episodes.


Assuntos
Apneia Obstrutiva do Sono , Bexiga Urinária Hiperativa , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Polissonografia , Qualidade de Vida , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Bexiga Urinária Hiperativa/terapia
3.
Int J Pediatr Otorhinolaryngol ; 149: 110867, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34385038

RESUMO

OBJECTIVE: The study aims to investigate into the correlation between clinical characteristics of pediatric obstructive sleep apnea (OSA) and the results of polysomnography (PSG), sleep apnea screening test (SAST) and cardiopulmonary coupling (CPC) respectively and compare their diagnostic values for pediatric OSA patients. METHODS: We recruited 239 pediatric OSA patients aged between 2 and 12 from Jan 1, 2017 to Jun 30, 2018. All the patients received PSG, SAST and CPC simultaneously and the results of these three different tests were compared and analyzed together with their clinical features. The relationship between the size of adenoid/tonsil and the severity of OSA was also analyzed. RESULTS: No statistically significant differences were noted between SAST and PSG in the oxygen desaturation index (ODI3) and lowest oxygen saturation (LsO2) respectively. No significant statistical difference was noted in the proportion of rapid eye movement sleep between CPC and PSG. The apnea-hypopnea index (AHI) from CPC was significantly lower than that from PSG. In the severe OSA group, no significant statistical difference was noted in AHI between these two tests. However, AHI from CPC was significantly lower than that from PSG in other groups. No statistically significant difference was noted in AHI and ODI3 among different groups graded by the size of adenoid or tonsil, suggesting that the size of adenoid/tonsil may not be highly related to the severity of OSA. CONCLUSION: SAST is an acceptable fast screening tool in the assessments of blood oxygen desaturation and further pediatric OSA screening. CPC is capable to screen severe pediatric OSA, but its results should be interpreted with caution for pediatric patients with non-severe OSA. The size of adenoid/tonsil may not be highly related to the severity of OSA.


Assuntos
Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Criança , Pré-Escolar , Humanos , Tonsila Palatina , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Sono REM
4.
Pan Afr Med J ; 39: 55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422178

RESUMO

Atrial fibrillation (AF), the most common sustained arrhythmia, is one of the risk factors with the largest relative increase in attributed cardiovascular mortality in Africa. There are important knowledge gaps in the epidemiology of AF in Africa, along with inadequate service provision for cardiac arrhythmias including AF. This paper comments on the available data on the prevalence and correlates of obstructive sleep apnea (OSA) in patients with AF in Africa. Two studies from Tunisia revealed a high prevalence of OSA based on polysomnography (77% and 90%) among patients with AF. Patients with OSA were more likely to report snoring, were older and had longer AF duration compared to those without OSA. The implications of these findings are discussed. Furthermore, key points on the mechanisms underlying the association between AF and OSA, the impact of OSA on AF-related outcomes and the screening and management of OSA in patients with AF are highlighted.


Assuntos
Fibrilação Atrial/epidemiologia , Polissonografia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Ronco/epidemiologia , Fatores de Tempo , Tunísia/epidemiologia
5.
R I Med J (2013) ; 104(7): 10-13, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34437659

RESUMO

Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep disorder that leads to excessive daytime sleepiness and poor quality of life. OSAS is characterized by intermittent hypoxia and sleep fragmentation and is associated with increased risk of cardiovascular and neurocognitive disorders. The focus of our article is to discuss the approach to diagnosis and management.


Assuntos
Médicos de Atenção Primária , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Pneumologistas , Qualidade de Vida , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia
6.
Sensors (Basel) ; 21(16)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34450866

RESUMO

Sleep Apnea is a breathing disorder occurring during sleep. Older people suffer most from this disease. In-time diagnosis of apnea is needed which can be observed by the application of a proper health monitoring system. In this work, we focus on Obstructive Sleep Apnea (OSA) detection from the Electrocardiogram (ECG) signals obtained through the body sensors. Our work mainly consists of an experimental study of different ensemble techniques applied on three deep learning models-two Convolutional Neural Network (CNN) based models, and a combination of CNN and Long Short-Term Memory (LSTM) models, which were previously proposed in the OSA detection domain. We have chosen four ensemble techniques-majority voting, sum rule and Choquet integral based fuzzy fusion and trainable ensemble using Multi-Layer Perceptron (MLP) for our case study. All the experiments are conducted on the benchmark PhysioNet Apnea-ECG Database. Finally, we have achieved highest OSA detection accuracy of 85.58% using the MLP based ensemble approach. Our best result is also able to surpass many of state-of-the-art methods.


Assuntos
Aprendizado Profundo , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Idoso , Eletrocardiografia , Humanos , Redes Neurais de Computação , Polissonografia , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico
7.
Med Clin North Am ; 105(5): 885-900, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34391541

RESUMO

Obstructive sleep apnea (OSA) is a complex medical disorder with significant impact on mortality, quality of life, and long-term cardiovascular outcomes. The apnea-hypopnea index does not correlate well with either quality-of-life measures or health outcomes, so other outcome measures must be evaluated in treatment of OSA. OSA can be successfully treated through behavioral, nonsurgical, and surgical methods with improvements in quality of life, morbidity, and mortality. Surgical intervention should be considered in patients who are noncompliant with or fail positive airway pressure use. As is true with PAP therapy, surgery for OSA improves mortality and symptoms of OSA even when the polysomnogram does not fully normalize.


Assuntos
Apneia Obstrutiva do Sono/patologia , Apneia Obstrutiva do Sono/cirurgia , Humanos , Polissonografia , Qualidade de Vida , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/mortalidade , Apneia Obstrutiva do Sono/terapia
8.
Artif Intell Med ; 118: 102133, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34412849

RESUMO

Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder. It is caused by an increased upper airway resistance during sleep, which determines episodes of partial or complete interruption of airflow. The detection and treatment of OSAS is particularly important in patients who suffered a stroke, because the presence of severe OSAS is associated with higher mortality, worse neurological deficits, worse functional outcome after rehabilitation, and a higher likelihood of uncontrolled hypertension. The gold standard test for diagnosing OSAS is polysomnography (PSG). Unfortunately, performing a PSG in an electrically hostile environment, like a stroke unit, on neurologically impaired patients is a difficult task; moreover, the number of strokes per day vastly outnumbers the availability of polysomnographs and dedicated healthcare professionals. Hence, a simple and automated recognition system to identify OSAS cases among acute stroke patients, relying on routinely recorded vital signs, is highly desirable. The vast majority of the work done so far focuses on data recorded in ideal conditions and highly selected patients, and thus it is hardly exploitable in real-life circumstances, where it would be of actual use. In this paper, we propose a novel convolutional deep learning architecture able to effectively reduce the temporal resolution of raw waveform data, like physiological signals, extracting key features that can be used for further processing. We exploit models based on such an architecture to detect OSAS events in stroke unit recordings obtained from the monitoring of unselected patients. Unlike existing approaches, annotations are performed at one-second granularity, allowing physicians to better interpret the model outcome. Results are considered to be satisfactory by the domain experts. Moreover, through tests run on a widely-used public OSAS dataset, we show that the proposed approach outperforms current state-of-the-art solutions.


Assuntos
Aprendizado Profundo , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Sono , Apneia Obstrutiva do Sono/diagnóstico , Sinais Vitais
9.
Sensors (Basel) ; 21(15)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34372308

RESUMO

Despite prolific demands and sales, commercial sleep assessment is primarily limited by the inability to "measure" sleep itself; rather, secondary physiological signals are captured, combined, and subsequently classified as sleep or a specific sleep state. Using markedly different approaches compared with gold-standard polysomnography, wearable companies purporting to measure sleep have rapidly developed during recent decades. These devices are advertised to monitor sleep via sensors such as accelerometers, electrocardiography, photoplethysmography, and temperature, alone or in combination, to estimate sleep stage based upon physiological patterns. However, without regulatory oversight, this market has historically manufactured products of poor accuracy, and rarely with third-party validation. Specifically, these devices vary in their capacities to capture a signal of interest, process the signal, perform physiological calculations, and ultimately classify a state (sleep vs. wake) or sleep stage during a given time domain. Device performance depends largely on success in all the aforementioned requirements. Thus, this review provides context surrounding the complex hardware and software developed by wearable device companies in their attempts to estimate sleep-related phenomena, and outlines considerations and contributing factors for overall device success.


Assuntos
Sono , Dispositivos Eletrônicos Vestíveis , Fotopletismografia , Polissonografia , Fases do Sono
10.
Comput Methods Programs Biomed ; 208: 106280, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34333204

RESUMO

BACKGROUND AND OBJECTIVES: while traditional sleep staging is achieved through the visual - expert-based - annotation of a polysomnography, it has the disadvantages of being unpractical and expensive. Alternatives have been developed over the years to relieve sleep staging from its heavy requirements, through the collection of more easily assessable signals and its automation using machine learning. However, these alternatives have their limitations, some due to variabilities among and between subjects, other inherent to their use of sub-discriminative signals. Many new solutions rely on the evaluation of the Autonomic Nervous System (ANS) activation through the assessment of the heart-rate (HR); the latter is modulated by the aforementioned variabilities, which may result in data and concept shifts between what was learned and what we want to classify. Such adversary effects are usually tackled by Transfer Learning, dealing with problems where there are differences between what is known (source) and what we want to classify (target). In this paper, we propose two new kernel-based methods of transfer learning and assess their performances in Rapid-Eye-Movement (REM) sleep stage detection, using solely the heart rate. METHODS: our first contribution is the introduction of Kernel-Cross Alignment (KCA), a measure of similarity between a source and a target, which is a direct extension of Kernel-Target Alignment (KTA). To our knowledge, KCA has currently never been studied in the literature. Our second contribution is two alignment-based methods of transfer learning: Kernel-Target Alignment Transfer Learning (KTATL) and Kernel-Cross Alignment Transfer Learning (KCATL). Both methods differ from KTA, whose traditional use is kernel-tuning: in our methods, the kernel has been fixed beforehand, and our objective is the improvement of the estimation of unknown target labels by taking into account how observations relate to each other, which, as it will be explained, allows to transfer knowledge (transfer learning). RESULTS: we compare performances with transfer learning (KCATL, KTATL) to performances without transfer using a fixed classifier (a Support Vector Classifier - SVC). In most cases, both transfer learning methods result in an improvement of performances (higher detection rates for a fixed false-alarm rate). Our methods do not require iterative computations. CONCLUSION: we observe improved performances using our transfer methods, which are computationally efficient, as they only require the computation of a kernel matrix and are non-iterative. However, some optimisation aspects are still under investigation.


Assuntos
Aprendizado de Máquina , Fases do Sono , Frequência Cardíaca , Humanos , Polissonografia
11.
Med Hypotheses ; 154: 110659, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34399170

RESUMO

Obstructive Sleep Apnea (OSA) is a common disorder characterized by periodic cessation of breathing during sleep. OSA affects daily life and poses a severe threat to human health. The standard clinical method for identifying and predicting OSA events is the use of Polysomnography signals. In this paper, a novel scheme based on an ensemble of recurrence plots (RPs) and pre-trained convolutional neural networks (RPCNNs) is proposed to improve the prediction rate of OSA. First, RPs were used to represent the dynamic behavior of single electroencephalogram (EEG) and electrocardiogram (ECG) signals for 60 s before and during OSA events. Then, using RPs, three prompt CNNs named ResNet-50 were fine-tuned, and their classification results were fused via the Majority Voting (MV) method to produce a final result concerning prediction. Next, the subject-independent Leave-One-Subject-Out Cross-Validation (LOSO-CV) and subject-dependent 10-fold Cross-Validation (10-fold CV) methods were used to validate the prediction rate from signals derived from the University College Dublin Sleep Apnea Database. Finally, the highest achieved average accuracy for the fusion level was 91.74% and 89.45% at the 10-fold CV and LOSO-CV. Additionally, our results outperformed state-of-the-art findings and could be recommended to predict and detect other biomedical signals. As a result, this predictive system can also be used to adjust the air pressure in sleep apnea patients' Automatic Positive Airway Pressure (APAP) devices.


Assuntos
Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Humanos , Redes Neurais de Computação , Polissonografia , Sono , Apneia Obstrutiva do Sono/diagnóstico
12.
Medicina (Kaunas) ; 57(7)2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34356971

RESUMO

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients' in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.


Assuntos
Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Endoscopia , Humanos , Faringe/cirurgia , Polissonografia , Apneia Obstrutiva do Sono/cirurgia
13.
Comput Biol Med ; 135: 104632, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34265554

RESUMO

Obstructive sleep apnea (OSA) is a serious sleep disorder, which leads to changes in autonomic nerve function and increases the risk of cardiovascular disease. Heart rate variability (HRV) has been widely used as a non-invasive method for assessing the autonomic nervous system (ANS). We proposed the two-dimensional sample entropy of the coarse-grained Gramian angular summation field image (CgSampEn2D) index. It is a new index for HRV analysis based on the temporal dependency complexity. In this study, we used 60 electrocardiogram (ECG) records from the Apnea-ECG database of PhysioNet (20 healthy records and 40 OSA records). These records were divided into 5-min segments. Compared with the classical indices low-to-high frequency power ratio (LF/HF) and sample entropy (SampEn), CgSampEn2D utilizes the correlation information between different time intervals in the RR sequences and preserves the temporal dependency of the RR sequences, which improves the OSA detection performance significantly. The OSA screening accuracy of CgSampEn2D (93.3%) is higher than that of LF/HF (80.0%) and SampEn (73.3%). Additionally, CgSampEn2D has a significant association with the apnea-hypopnea index (AHI) (R = -0.740, p = 0). CgSampEn2D reflects the complexity of the OSA autonomic nerve more comprehensively and provides a novel idea for the screening of OSA disease.


Assuntos
Apneia Obstrutiva do Sono , Sistema Nervoso Autônomo , Frequência Cardíaca , Humanos , Polissonografia , Análise de Sistemas
14.
Clin Geriatr Med ; 37(3): 377-386, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210444

RESUMO

Sleep-related complaints are so common in older adults that it may be difficult to distinguish whether the complaint is a consequence of normal aging or a disease process. The elderly are more likely to have common medical problems that affect sleep, and the most common sleep problems, including sleep apnea and insomnia, are more prevalent in this demographic. This article briefly describes normal sleep in general, the clinical assessment of sleep complaints, and expected changes with aging, with an overview of the epidemiology of insomnia and sleep apnea in this age group.


Assuntos
Envelhecimento , Distúrbios do Início e da Manutenção do Sono , Fases do Sono , Transtornos do Sono-Vigília/etiologia , Sono/fisiologia , Idoso , Humanos , Polissonografia , Síndromes da Apneia do Sono
15.
Clin Geriatr Med ; 37(3): 445-456, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210449

RESUMO

Obstructive sleep apnea (OSA) presents as repetitive interruptions of ventilation >10 seconds during sleep as a result of upper airway obstruction resulting in increased respiratory effort. Intermittent hypoxia causes physiologic changes resulting in increased catecholamine production, increased total peripheral resistance, tachycardia, and increased venous return, leading to increased cardiac output, hypertension, tachyarrhythmias, left ventricular hypertrophy, and heart failure. OSA causes an abnormal dip on 24-hour ambulatory blood pressure monitoring. Definitive diagnosis is made by polysomnography. Continuous positive airway pressure (CPAP) remains the first-line treatment. Effective treatment using CPAP reduces blood pressure and is indispensable for proper management of atrial fibrillation.


Assuntos
Doenças Cardiovasculares/etiologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Hipertensão/etiologia , Apneia Obstrutiva do Sono/terapia , Idoso , Fibrilação Atrial/etiologia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Eletrocardiografia Ambulatorial , Humanos , Polissonografia , Apneia Obstrutiva do Sono/complicações , Taquicardia Ventricular/etiologia
16.
Clin Geriatr Med ; 37(3): 469-481, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210451

RESUMO

Central sleep apnea (CSA) is characterized by intermittent repetitive cessation and/or decreased breathing without effort caused by an abnormal ventilatory drive. Although less prevalent than obstructive sleep apnea, it is frequently encountered. CSA can be primary (idiopathic) or secondary in association with Cheyne-Stokes respiration, drug-induced, medical conditions such as chronic renal failure, or high-altitude periodic breathing. Risk factors have been proposed, including gender, age, heart failure, opioid use, stroke, and other chronic medical conditions. This article discusses the prevalence of CSA in the general population and within each of these at-risk populations, and clinical presentation, diagnostic methods, and treatment.


Assuntos
Respiração de Cheyne-Stokes/fisiopatologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/terapia , Sono/fisiologia , Idoso , Humanos , Polissonografia , Prevalência , Qualidade de Vida , Apneia do Sono Tipo Central/epidemiologia
17.
Clin Geriatr Med ; 37(3): 483-490, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210452

RESUMO

Rapid eye movement (REM) behavior disorder (RBD) is characterized by loss of skeletal muscle atonia that can lead to dream enactment. This condition can cause harm to patients and their bed partners if appropriate safety measures are not ensured. This condition is often the initial presenting symptom in a group of complex neurodegenerative processes. Definitive diagnosis requires a thorough history and an in-laboratory polysomnogram to look for evidence of REM sleep without atonia. Treatment options are limited but consist of sleep safety measures and pharmacotherapy. Patients diagnosed with idiopathic RBD associated with alpha-synucleinopathy are likely to have progression of disease.


Assuntos
Parassonias/complicações , Transtorno do Comportamento do Sono REM/diagnóstico , Parassonias do Sono REM/fisiopatologia , Sono REM/fisiologia , Idoso , Humanos , Masculino , Parassonias/fisiopatologia , Polissonografia/métodos , Sono
18.
Artigo em Inglês | MEDLINE | ID: mdl-34202447

RESUMO

This article investigates the effects of continuous positive airway pressure (CPAP) on hearing impairment in sensorineural hearing loss (SNHL) patients with sleep-disordered breathing (SDB). This retrospective and observational study took place from September 2016 to February 2021, accumulating 77 subjects with SNHL and SDB (60.7 ± 11.1 years). Of which, 28 received CPAP treatment (63.0 ± 8.5 years). In our methodology, hearing thresholds at low, medium, high, and average frequencies are assessed by pure-tone audiometry at baseline (BL), three (3 m), six (6 m), and 12 (12 m) months. Our results show that the BL of at least three frequencies in all subjects is positively associated with old age, males, smoking, alcohol, coronary artery disease, hypertension, and apnea-hypopnea index [AHI] (all p < 0.05). Moreover, low, medium, and average frequencies are negatively correlated at CPAP-6 m (-5.60 ± 2.33, -5.82 ± 2.56, and -5.10 ± 2.26 dB; all p < 0.05) and CPAP-12 m (-7.97 ± 2.74, -8.15 ± 2.35, and -6.67 ± 2.37 dB; all p < 0.01) against corresponding measures of CPAP-BL. High, medium, and average frequencies positively correlated with age (p < 0.001 for high and average frequencies and <0.01 for medium frequencies). We conclude that in SNHL patients with SDB, hearing thresholds at low and medium frequencies improves under CPAP use after six months, which persists at least to the end of one year.


Assuntos
Perda Auditiva Neurossensorial , Síndromes da Apneia do Sono , Idoso , Audiometria de Tons Puros , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos
19.
Sleep Med ; 84: 352-355, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242925

RESUMO

OBJECTIVES: Adherence to Continuous Positive Airway Pressure (CPAP) in children can be challenging. Advancements in CPAP technology have potential to influence adherence. The aim of this study was to compare adherence rates of children with obstructive sleep apnoea (OSA) initiated on autotitrating CPAP (APAP) with remote modem monitoring compared to a cohort started on fixed pressure CPAP alone. METHODS: Children aged over 3 years starting APAP at our centre between February 2017 and February 2020 were included. Therapy data was obtained for the initial 90 days. Data was compared to a cohort of children started on CPAP between July 2004 and September 2008. RESULTS: A total of 61 patients with a median age of 14.3 years formed the APAP group, and were significantly older than the CPAP group who had a median age of 8.6 years (p = 0.02). Co-morbid conditions were present in 51% compared with 69% in the earlier cohort (p = 0.11). No significant difference was found in any adherence parameters between the groups. The value closest to achieving a significant difference was hours used per day used, with an median of 5.2 h in the CPAP group compared with 7.0 h in the APAP group (p = 0.07). Two-way ANOVA including age group (above or below 13 years) showed that both age group and treatment group (CPAP vs APAP) were significantly associated with a difference in adherence (F = 4.41, p = 0.006), with mean hours used on days used being highest in the APAP group aged under 13 years. However no significant interaction was found between age and treatment group. CONCLUSION: Despite the convenience for patients with outpatient initiation and ability to achieve optimal pressures quickly and remotely, our results show no improvement in adherence using APAP with remote monitoring, with the possible exception of children aged under 13 years. A large randomized controlled trial would be required to confirm these findings.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Cooperação do Paciente , Polissonografia , Apneia Obstrutiva do Sono/terapia
20.
Sleep Med ; 84: 389-396, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34252845

RESUMO

BACKGROUND: Pantothenate kinase-associated neurodegeneration (PKAN) is a rare neurologic disorder included in the group of neurodegeneration with brain iron accumulation diseases (NBIA). Information regarding sleep in patients with PKAN is limited. OBJECTIVES: To describe the clinical and polysomnographic characteristics of sleep in six patients with genetically confirmed PKAN. METHODS: The evaluation included a clinical interview, sleep questionnaires -Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS)- and a video-polysomnography (VPSG). In addition to standard sleep measures we manually quantified sleep spindle density in stage N2 and rapid eye movements in REM sleep comparing the results with matched controls. Quantification of EMG activity in REM sleep was performed following standard criteria. RESULTS: All the patients reported at least one sleep complaint, most commonly sleep fragmentation (4/6) and sleep onset insomnia (3/6). ESS and PSQI were abnormal in 3/6 and 4/6, respectively. VPSG showed in 4/6 decreased ocular movements during REM sleep, an increase in sleep spindles in 3/6 (all of them with deep brain pallidal stimulation), an absence of slow wave sleep in 2 and undifferentiated NREM sleep and delayed sleep phase in one. Three patients had an abnormal sleep apnea/hypopnea index, and 2 periodic limb movements of sleep. REM sleep muscular atonia was preserved in all. CONCLUSIONS: Sleep disorders are common in patients with PKAN. Although our sample is small and heterogeneous, with different symptomatic treatments possibly influencing the results, it suggests that evaluation of sleep should be considered in their management.


Assuntos
Neurodegeneração Associada a Pantotenato-Quinase , Sono de Ondas Lentas , Humanos , Neurodegeneração Associada a Pantotenato-Quinase/genética , Polissonografia , Sono , Sono REM
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